Snap Shot: Crane 3 Survey Findings Female Sex Workers and Sexually Exploited Children in Kampala, Uganda 2021

In MakSPH collaboration with Population Council, Centers for Disease Control and Prevention (CDC), Infectious Diseases Institute, and Ministry of Health conducted a respondent-driven sampling (RDS) survey between May and October 2021 using a single survey office in downtown Kampala.

Dubbed Crane survey, it was conducted from among 1,589 Female sex worker (FSW) and sexually exploited children (SEC) of ages 15-49 years using audio computer-assisted self-interviews. During this study participants’ blood was tested for HIV, viral load, and active syphilis; and cervicovaginal swabs were tested for human papilloma virus (HPV).

The highlights

• HIV prevalence was high, rose sharply with age and was similar to past Crane surveys in Kampala. The prevalence of unsuppressed HIV (among all FSW/SEC) was smaller than previous surveys (19%) due to treatment.
• Median age was 29 years; half were 23 to 35 years old (participants under 18 years were referred to protection services). Most had dependents and had experienced homelessness at some point in their life. On average, FSW/SEC had been selling sex for 2-3 years.
• Status awareness and treatment status are based on self-report and/or being virally suppressed. 84% of all FSW/SEC living with HIV were virally suppressed.
• One in seven FSW/SEC tested positive for active syphilis, and more than one in three tested positive for a high-risk HPV strain (high-risk strain for cervical cancer).
• Only one quarter of FSW/SEC reported that their antenatal care (ANC) providers knew of their sex work. Three out of five had ever sold sex while pregnant and two out of five had ever terminated a pregnancy.
• Most stated they had fewer clients due to COVID-19 and less access to condoms. However, access to HIV testing, treatment, pre-exposure prophylaxis (PrEP) or other services was largely unaffected by COVID-19.
• Two out of five FSW/SEC screened positive for alcohol misuse; a quarter consumed alcohol during sex work (SW) and a quarter consumed drugs during sex work. Nine out of 10 screened positive for likely depression and one in ten ever injected drugs.
• Two out of five FSW/SEC ever experienced stigma. The same proportion reported ever being denied healthcare. Sixty percent felt comfortable disclosing their sex work to a health care worker (HCW) and yet two thirds also reported avoiding seeking healthcare for fear of stigma.
• Violence: Almost half of FSW/SEC reported having been raped: 27% in the last 12 months, another 21% more than 12 months before the survey. Similarly, more than half reported having been hurt by others: 34% in the last 12 months, 20% more than 12 months ago. SEC and other abused FSW were actively referred for psycho-social support.
• Condoms: During the last three commercial sex acts, 71% reported having used a condom all three times, whereas 13% reported not having used any condoms, the remaining 16% used condoms sometimes.

See details in summary report attached.